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April 1914


Arch Intern Med (Chic). 1914;XIII(4):568-574. doi:10.1001/archinte.1914.00070100061003

Case XX (2).—History.  —J. S., aged 39, a Polish laborer, was admitted May 14, 1907, to the service of Dr. Heinick with the following history: The patient states that his present trouble began three months ago with severe pain in the right half of the head and face, most marked, however, over the malar prominence. This continued without remission until a month ago, at which time he began to experience pain in the right hip and knee. The latter became much swollen, and so painful that walking or standing was prevented.A week later, pain was felt in the anterior part of the chest and in both shoulders, especially on inspiration or movements of the shoulders. Two weeks ago the left wrist became tender and swollen. A slight cough, present since the onset, has been more marked during the last two months, with blood occasionally in the sputum.

Owing to the fact that the lesions of the right eye developed during the course of the illness, considerable speculation was aroused as to its nature. Unfortunately permission to remove the eye was not obtained. The eyeball was therefore rotated, a sterile puncture made and a portion of the vitreous humor removed. From this, a pure culture of blastomycetes was obtained. In view of this result the assumption that the lesion was one of metastatic blastomycosis is perhaps not far-fetched. Supporting this view are the facts that pain noted about the region of this eye and disturbance of vision, indicating its involvement, were among the first symptoms.
See bacteriological examination.